Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000543 DEA: 031N0104 EFIS: 0324000268
QA Service Level: 1
DIST-CO-RTE-PM: 03-SAC-160-0/0
Work Description: continuation of emergency project EA 03-4H9504 Delta Moveables.
Location Description:
Contractor Name: Golden State Bridge Inc.
Contractor Address: 3701 MALLARD DRIVE BENICIA CA, 94510
Resident Engineer: Rusty Danna Structure Rep.: Rusty D'Anna
DIME Sample ID: 2026-02-26-1
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Bay Area Field Office
Sample Organization Contact: (916) 284-6784
Type of Sample: Quality Assurance
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 02/26/2026
Date that the sample was received by the laboratory/organization performing the testing: 03/06/2026
The quantity of what the sample constitutes: 2 Assemblies
A brief description of the sample: A325 Fastener Assembly
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: XKT Engineering
Rocap Number(s): Unknown
Heat Number(s): 100101259, 42329370, 1000124630, 3800016174
Nut Mfg. Lot Number(s): W000165726
Washer Mfg. Lot Number(s): 413255
Bolt Specification: A325
Bolt Length(s): 1-1/2"
Nut Specification: A563
Washer Specification: F436
Finish: HDG
Diameter/Size: 1/2"
Bolt Mfg. Lot Number: 431956A
Rocap Test Requirement(s): Unknown
Lubricant Requirements(s): Unknown
Washer Inner Diameter(s): Unknown
DIME Test ID: 2026-02-26-1-1
Test Method: ASME B1.2-83r17: (Pitch Diameter) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Pitch Diameter)
Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: brian.ellis@dot.ca.gov
Organization Phone: (916) 380-8623
Data has not been verified.
DIME Test ID: 2026-02-26-1-2
Test Method: ASME B1.2-83r17: (Pitch Diameter) Gages and Gaging for Unified Inch Screw Threads - Errata May 1992 (Pitch Diameter)
Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: brian.ellis@dot.ca.gov
Organization Phone: (916) 380-8623
Data has not been verified.
